Regina Ballroom Dancing Club
Box 3787 i Regina, SK S4P 3N8 i (306) 586-9771 i www.rbdc.ca
2 0 1 0 / 1 1 M E M B E R S H I P & V O L U N T E E R AP P L I C AT I O N
** Complete FRONT & BACK of 1 form for each person. Please print and number clearly. **
NAME: (last) ____________________________________ (first) _______________________ GENDER: M or F
CITY/TOWN: __________________________________________ POSTAL CODE: ______________________
PHONE: (home) _____________ (work) ________________ EMAIL:___________________________________
Are you registering with a dance partner? ___ Yes ___ No PARTNER’S NAME (if applicable): _______________________
Membership entitles you to attend one (1) class per week of instruction.
You must be 18 years of age or older to be a member of RBDC.
MEMBERSHIP OPTIONS Please circle the membership option(s) that applies to you:
Full Year $80 Fall Semester $50 Winter Semester $50 Full-time Student Rate
July 1 – June 30 July 1 – Dec 31 Jan 1 – June 30 $40
CLASS SELECTION Indicate your class selection below:
The following classes will take place at the Austrian Club – 320 Maxwell Crescent
BEGINNERS INTERMEDIATE 1 INTERMEDIATE 2
_____ Mon 6:30 pm _____ Wed 8:00 pm _____ Mon 8:00 pm _____ Wed 9:00 pm
_____ Tues 6:30 pm _____ Thurs 6:30 pm _____ Tues 8:00 pm _____ Thurs 8:00 pm
_____ Tues 9:00 pm _____ Wed 6:30 pm
_____ Thurs 9:00 pm
The following classes will take place at the Lakeview United Church – 3200 McCallum Ave.
BEGINNERS INTERMEDIATE 3 ADVANCED
_____ Mon 9:00 pm _____ Mon 6:30 pm _____ Mon 8:00 pm
RBDC reserves the right to limit class sizes. If the class you have chosen is over limit, you will be contacted to select another class.
Please assume that you are registered in the class you selected unless you hear otherwise from RBDC.
Make your cheque or money order payable to RBDC. NSF charge is $20.
Submission of this form stipulates the following: “Each signatory agrees to hold the executive of the Regina Ballroom Dancing Club
Inc. (RBDC) and their agents, heirs and assigns harmless from all suits, claims or demands of every kind and character arising out of and in
conjunction with attendance at any RBDC dance class or function (event). I understand the physical risks of participating in dance classes
and social dancing.
I accept these risks and all others arising from membership in the RBDC and assume full responsibility for any injury or personal
damages resulting from my attendance at any RBDC dance class or function (event).
I certify that I am 18 years of age or older.”
Signature _________________________________________________________ Date ____________________
(each person registering on this form MUST sign this waiver in order to register)
Membership information is used to draw prepare class lists, to mail out registration information, and to contact members about special events.
Your information may be shared with instructors or Board members as required, but will never be shared with an outside organization or individual.
For Office Use Only:
Initials __________ Amount PD __________ Cash/Cheque # _________ Receipt # __________
**Volunteers are the heart of our Club! To volunteer please see back of form**
VOLUNTEERING WITH RBDC
The Regina Ballroom Dancing Club Inc. (RBDC) is a non-profit club run by volunteers. Volunteering is a rewarding
experience that allows you to give back to your community, meet people, make friends, share your skills and abilities
and develop new ones, and to enjoy many more opportunities to dance.
RBDC welcomes any member who is interested in volunteering to contribute and help make
our club the best it can be.
Along with all the benefits of RBDC membership, anyone who volunteers at RBDC is invited to attend an appreciation
night at the end of the winter semester. At the appreciation night, volunteers are recognized for their valuable
contributions, enjoy a catered dinner and a night of dancing.
If you are interested in volunteering with RBDC, please checkmark your selection(s) from any of the activities listed
below. By making a selection(s) you are adding your name to a list of possible volunteers. This is not an obligation
or promise of commitment. You will be contacted by a member of the RBDC board or an event coordinator to
confirm your interest and availability.
Ticket seller Newsletter contributor
Registration night Website contributor
Practice Dance Committee Volunteer dance partner (see details below)
Dance event decorator Dance event set up/take down
NAME: ____________________________________________________ PHONE #: ________________________
The class I am enrolled in as a member is: ___________________________________________________________________________________
Please note that the following are elected or formally appointed volunteer positions, and therefore not included above:
Director on the Board; Chief Instructor; Instructor; Routine Coordinator; Club Archives; Club Music Coordinator: Sound
VOLUNTEER DANCE PARTNERS
In some classes, we have uneven female/males ratio enrolled. We are asking for volunteers to be partners for the extra ladies. If
you would be willing to attend classes (other than the one you are enrolled in) to be a spare partner, please select which class(es)
you would be interested in attending. The club will determine the maximum number of volunteer partners required and assign the
volunteer partners to specific dance classes as needed. A Volunteer Dance Partner may be requested/assigned to attend more
than one evening or class to help out. We attempt to give all members an equal chance to dance. Volunteer partners may dance
at their own level or lower. A special nametag will be issued for the volunteer partners. You must wear this nametag when
dancing as a Volunteer Dance Partner. Please note that to act as a Volunteer Dance Partner, you must read and agree to abide
by the Volunteer Dance Partner Policy. You can obtain a copy of this policy on Registration Night, in the first week of classes, or
online at www.rbdc.ca An orientation session will be held in early fall.
NAME: _______________________________________________ PHONE #: ____________________________
The class I am enrolled in as a member is: __________________________________________________________________________________
As a Volunteer Partner I would be interested in volunteering on (please specify which night/s you would like to volunteer for):
The Following classes will take place at the Austrian Club – 320 Maxwell Crescent, Regina, SK
BEGINNERS INTERMEDIATE 1 INTERMEDIATE 2
____ Mon 6:30 pm ____ Wed 8:00 pm ____ Mon 8:00 pm ____ Wed 9:00 pm
____ Tues 6:30 pm ____ Thurs 6:30 pm ____ Tues 8:00 pm ____Thurs 8:00 pm
____ Tues 9:00 pm ____ Wed 6:30 pm
____Thurs 9:00 pm
The following classes will take place at the Lakeview United Church – 3200 McCallum Ave., Regina, SK
BEGINNERS INTERMEDIATE 3
____ Mon 9:00 ____ Mon 6:30